Breast Health (4 questions)

Question 1

Normal vs abnormal nipple discharge

Answer 1

• Clear or milky usually non cancer
• Bloody or spontaneous discharge is cause for concern

Question 2

What are fibroadenomas and when would they be a concern?

Answer 2

• Most common benign tumor
• Estrogen stimulated, may grow over time in cases such as pregnancy
• Usually painless
• It is only removed if grows or causes pain

Question 3

What are intraductal papillomas and are they removed or not?

Answer 3

• Growths in the milk ducts
• Cause clear or bloody discharge
• Removed for full diagnosis

Question 4

What are calcifications and are they removed/investigated or not?

Answer 4

• Characterized as macro or micro
• Caused by age, inflammation and trauma
• Macrocalcifications do not need investigation
• Microcalcifications in certain shapes and patterns require imaging and biopsy

Question 5

What are fibrocystic changes and do they warrant interventions?

Answer 5

• Occur in the glandular (lobules & ducts) and stromal tissues
• Breast may feel lumpier, thicker, swollen, sore or tender
• May warrant biopsy

Question 6

Who is prone to fibrocystic changes?

Answer 6

Affect ½ of all woman between 20 and 50 years of age

Question 7

What are breast cysts and should they be removed?

Answer 7

• Fluid filled sacs, movable lumps, resolve after her period
• Evaluated by ultrasound
• If painful, may be drained in the office
• Remove cyst if fluid is bloody

Question 8

What makes a microcalcification worrisome?

Answer 8

four to five clustered - potential for cancer

Question 9

Characteristics of breast cancer

Answer 9

• Occur in one breast
• Are singular lumps
• Very firm to hard
• Feels uneven with irregular borders
• Less likely to cause pain

Question 10

Risk factors for breast cancer: age

Answer 10

55 and older

Question 11

Risk factors for breast cancer: gender

Answer 11

100X more common in women than men
2 out of 3 women with invasive breast cancer

Question 12

Breast cancer risk factors: genetic factors

Answer 12

5-10% linked to inherited mutations

Question 13

ACR cancer screening guidelines

Answer 13

• Annual screening mammogram
  
  • Age 40 for general population
  • Age 25-30 (or) 10 years prior to age of affected 1^st degree relative’s diagnosis of premenopausal breast cancer (OR) if lifetime risk ≥20% based on FH
  • Age 25-30 for BRCA carriers
  • Fails to detect 20% of cancer that become palpable within 1 year

Question 14

With what kind of breast tissue is cancer easier to detect with a mammo?

Answer 14

fattier w/fewer glands (happens with age)

difficult in dense breasts

Question 15

What is a 3D mammogram

Answer 15

Tomosynthesis:

• Views the breast in thin “slices” rather than as a whole
• Improves detection of lesions and reduces false positives
• Proven to decrease call-back rates by 30%+
• Quickly becoming new standard of care for screening

Question 16

What test is most helpful in determining if a palpable mass is solid or fluid filled?

Answer 16

U/S

Used as a backup tool in evaluating dense breast tissue

Question 17

When would an MRI be used to investigate a breast lump?

Answer 17

High Risk Screening Tool

• Usually ordered by a Specialist
• BRCA 1/2 mutation carriers
• Strong family history
• Lifetime risk ≥25% per risk assessment model

Question 18

What are findings that would increase risk for breast cancer?

Answer 18

• Lobular Intraepithelial Neoplasia (LIN)
• Lobular Carcinoma In Situ (LCIS)
• Atypical Ductal Hyperplasia (ADH)

Question 19

How is LCIS usually found?

Answer 19

• Lacks clinical or mammographic signs
• Incidental microscopic finding in tissue biopsied for another reason

Question 20

What is the relationship of LCIS to invasive breast cancer?

Answer 20

• 7-10-fold increased risk of invasive breast cancer, or 1%/year, or 25% lifetime
  
  • Equal risk for both breasts
  • Most are actually invasive ductal
• Considered a risk factor, but not a precursor lesion
• Consider chemoprevention in these patients

Question 21

What fraction of breast tumors are estrogen receptor positive?

Answer 21

~2/3

Question 22

How do SERMs work and what are examples of SERMs?

Answer 22

Selective Estrogen Receptor Modulators - inhibit ERs

Tamoxifen, Raloxifene

Question 23

By how much do SERMs decrease risk of BC?

Answer 23

50%

Question 24

HOw do aromatase inhibitors work and what are examples?

Answer 24

inhibit estrogen

Exemestane

Question 25

What limits the use of aromatase inhibitors?

Answer 25

• only for post menopausal women
• bad side effects:
  
  • common: Vasomotor, myalgias, arthralgias, vaginal dryness
  • Rare: Osteoporosis

Question 26

By what percent do aromatase inhibitors reduce the risk of BC?

Answer 26

90%

Question 27

Side effects of SERMs

Answer 27

• Common: Vasomotor, leg cramps, vaginal discharge, menstrual irregularities
• Rare: DVT/PE, uterine cancer, cataracts

Question 28

Why would SERMS or AIs be Rxed?

Answer 28

chemoprevention

e.g., ADH, LCIS, risk factors >25

Question 29

What is BI-RADS?

Answer 29

mammography assessment categories - standard numerical codes assigned by a radiologist

Question 30

What are the BI-RADS assessment categories?

Answer 30

· 0: Inconclusive

· 1: Negative

· 2: Benign finding(s)

· 3: Probably benign

· 4: Suspicious abnormality

· 5: Highly suggestive of malignancy

· 6: Known biopsy – proven malignancy